One of my first experiences in Long Term Care

In January of 2010, I was offered a position as part of the Administrative Staff of a Long Term Care Facility called “Plaza on the River. This is a beautiful complex. Its all red brick, has a capacity for about 65 residents, and is attached to a three level “Assisted Living” complex that provides apartments for people who are aging or disabled to the point where they need assistance with every day tasks.

The portion of the facility I was going to be part of managing was a “long Term Care/Physical Rehabilitation” facility. Basically, we had a few residents who had chosen this as their home and a few folks who were at their “end of life” and needed “Comfort Care” as they “passed away.”

 Primarily, this was a short term type of facility for people who had broken legs, broken hips, recovering from surgery, battling pneumonia…things like that….The projection of each resident was generally no longer than a couple of months.

What my job was here was to help people get services when they discharge from our facility, help them manage Medicare and Medicaid problems and then to generally just be present for them and their families to have someone to talk with to deal with the emotions associated with aging (along with a multitude of other tasks).

One of the things we seem to avoid as humans is prepare for our demise. It’s a reality, but not one any of us ever want to entertain. This game of life we are playing, be fully aware, none of us are getting out of it alive!

I am like most people…I don’t think I am ever going to get to a point where I can’t manage my own body. I don’t look in the future and see myself losing control of my bowels or bladder…Being unable to walk, getting dementia, and many of the other problems associated with people as they age.

I see myself passing away in my sleep, surrounded by those who love me, fully capable of managing my life and my body…OR, going out in a blaze of glory… I love the metaphor…

“Life was not meant to bring to the grave a perfect and pristine body in ideal health and great shape, but rather to come to the end totally worn out, used up, sliding in sideways, with a beer in one hand and screaming…..WOOOOOO-HOOOOO….WHAT A RIDE!”

But after working in this field, I see that there are MANY other possibilities!

I don’t see death the same way as many people though….Nothing great in this life comes without some kind of risk, pain or “suffering” (or so it seems) so I see death as not an end, but a new beginning. I really do look at it that way.

If death is what we have all been told it is and we go on to some magical place, all our wishes are become reality, “Streets paved with gold” etc…Then why do we avoid it??? Why do we fear it so much?

The unknown…that’s why…Because no one knows for sure what happens when that heart of ours takes the last beat. Even the greatest of people with faith question their demise and what’s next.

I have worked with a variety of people in different areas of my professional career. I have found that this field really offers so much gratitude. You see, when people start to age and have the complications associated with aging, many times family, friends and other people don’t want to be witness to this inevitable circumstance. Thus, many elderly people don’t have family and friends around them like they did when they were “well.”

In turn, what happens is those who DO choose to be in their life and see them every day, they are so grateful for you being there…Smile at one of these little people as you walk down the hall, and it brightens their day, spend five minutes with them talking to them and you have just made their week better. Spend time with them day to day and they are so very appreciative of you…I have never seen as much gratitude as I have in this field…Genuine gratitude for just “being” with people…So very rewarding.

I was very blessed with amazing experiences in my time in this field (as I have documented in my stories) and these experiences truly impacted my life in ways that have changed me forever. This is the first of those experiences.   

On 2-10-10; I was able to have my first daunting task as a Social Services Director. On or around 2-1-10, I had a new admit into my facility and as part of my duties, it is my job to assess the person and find out their cognitive state, any types of fears they might have, who their family is, if they have their Advanced Directives updated and in place, etc.. About 30 minutes of face to face time where you are just “getting to know” people. I have heard so many great stories and life experiences in these times.

This was the common practice with each admit to the facility. They get admitted, and as soon as possible, I would go meet with each person, introduce myself, and go through a series of questions with them. This always spurred conversation outside of that required information and I never was bored with what this would unravel in their life story.

 
This little lady is a widow, was married for over 40 years before losing her husband and they never were able to have kids. As she told these stories, she would have to stop to contain the emotion she was feeling, apologize to me, and carry on.Well, on this admission, this lady (Betty) and I sat and chatted for about an hour or so. She explained her condition, Congestive Heart Failure, and her current living status, her past, her life story, etc…

I always found it odd that people would apologize to me for showing the emotion they were feeling…

 “I am sorry; I don’t mean to cry…”

Why? Why are we sorry for showing our emotions? Where did we learn in this twisted life that we have to apologize for our feelings? It’s a natural response to reflection of experiences and there is no need to apologize to anyone for how you feel…It’s your life, your experience and it’s magical to you! I never see emotions as something to apologize for.

 Because of her health, she has been unable to get out of her house for social activities or even to go to a movie. She was completely dependant on a Health Services Organization for her shopping and any other activities that might take her from her home. Her health had diminished to the point where she could no longer drive and people just don’t realize how limiting this simple restriction can be.

Take a week and TRY to not leave your house or drive or go to the store for something you need. When people lose the ability to drive or get themselves from one point to another, their life experience just changed in a huge way. The independence that comes with the ability to drive is something I think many of us take for granted. The ability to just be able to walk out the door and walk a block down the street is another thing we all seem to take for granted… This is a huge deal for people and we don’t ever consider it, because we don’t like to think about this as a possibility.

As a result of all of this, over time, she has lost everything in regards to her social life. She can’t go to Bingo, Church, Eastern Star, anything…She is limited to her space where she lives. And as she explained it, when it all first started, she had visitors and friends that would stop by but they would slowly start to fade away…Stop coming by, calling, helping…And she was too proud to call for any assistance.

She has no family and no friends... The only family she does have is an estranged niece from her husband’s side of the family that lives in Arizona who she has no interaction with... She stated to me that her doctor told her she might have 2 years left to live.¦ She is alone in the world. Completely and totally ALONE…

TRY to grasp that concept…If you got a phone call from someone today or yesterday…if you went to the “Convenience” store in the last few days or to the Wal-Mart…You CANT grasp this. And people wonder why elderly folks start to become animal hoarders…At least the love of animals in unconditional.

She had a great life…A great marriage and told me wondrous stories of her travels, her Christmases, Thanksgivings, times and places that were special to her and her husband. She went on and on, stopping from time to time to wipe her eyes and blow her nose.

She has an oxygen concentrator and a nose canual that she wore due to her complications and every three sentences or so, she would have to stop and breathe deeply through her nostrils to inhale the oxygen that was richening her depleted blood. I could not help but be emotional over this woman and her life as it was in this moment. What a blessing it is for me to be someone who really cares about her and wants to hear all of the things she wants to tell me about. She was making my life richer, and I was making her life richer…


WIN/WIN!!
 Well, over a weeks time, I have been checking on her every day, stopping in to chat, taking a minute just to see how she was doing and although she was suffering, she would always s give me as pleasant a response as she could… “Rough day today Brad, but it was good” “Not sure how long this old tickers going to hang on, but I sure appreciate you checking on me” “Come in, sit down, How’s your wife doing now that she is getting ready to graduate?” We had become “friends”

She has been declining in her health and every day she seemed to be breathing harder, cringing in pain more, she was not seemingly getting any better.

Part of rehabilitation therapy in Long Term Care is getting people back to doing everyday things…Dressing themselves, bathing themselves, etc… Betty had come to the facility directly from the hospital and to the hospital by ambulance from her home. She had no clothes other than what she was wearing and she needed to get home and get some clothes.

I spoke to Betty about getting her some clothes and she said…

“If you can get someone to take me home, I will get me some. I don’t have anyone to bring me any clothes.”

Betty had not been out of a hospital type setting in weeks and I felt this was a great opportunity for her to get out of the building and back to her house…An encouraging step to have her get back home. She had stated in our conversations that she didn’t like being in hospitals so I figured this would maybe be a “nudge” to get her driven to get back to where she was comfortable.

Our transport vehicle and driver was always busy. The transporter is always taking people to appointments, going to the hospital, taking forms and other materials to and from Doctors offices…It’s a really busy job.

I talked to the transporter and Betty’s therapist and asked them both if they thought getting her back to her house, out of the facility and visiting her home would be a good idea.

The therapist said it was a great idea and many times this spurs a desire to “get better” and encouraged me to make this happen. The driver explained her schedule was busy but if it could wait for a day or two, she would be able to get her scheduled in and get her home.

I went to talk to Betty about it and she was not feeling very well on this day. She said she would like to go to her house, but she was feeling “ill” that day and wanted to know if we could schedule it in a day or so.

PERFECT!! This was what I wanted to hear and told her that I would get to work on scheduling her trip to her house.

The next day, the transported told me that she had an opening, and we went to talk to Betty…She was distant, not really responsive to my requests and then it hit me…

“Maybe she didn’t want to go home because it was sad there…That empty house, that place where she was so secluded…Of course she didn’t want to go back to that cave she lived in.”

The next day was when the scheduling was open and I went to talk to Betty again….

“OK Betty, today’s the day, the transporter is going to come and get you in an hour or so”

“Oh Brad, I don’t really feel too good”

She looked “ashy” and appeared to be struggling more with her breathing, but I still felt it would be a good thing for her to get out into the sunshine and at the very least, get outside of the “hospital setting.”

I told her…

“Come on Betty, these clothes you have are not going to be good enough for your stay, let’s get you out and get you some clothes and get you out of this place for a little bit.”

She groaned and nodded, gasping for her oxygen but agreed to take the trip.

The transporter and another girl took Betty to her house that day and when they returned, they both found me at my desk and sat down…

“Brad, oh my God…You should see her house! It is so cluttered and full of trash and clothes and other junk…My God, you could hardly move through the house. There were ally ways made through her trailer that led to different rooms and only space in areas where she would sleep and sit and watch TV…She is a hoarder!”

I had been in many houses like this in my years in Law Enforcement. The TV shows that document hoarder’s lives are very real but there is no way one can actually grasp the scenario unless you have been in one. They usually smell of mold, trash, feces, dead animals, cigarettes, dirt…Generally they are VERY nasty and so terribly unsanitary. I have even been in some where the carpet squishes from moisture build up and fluids from various trash items.

I have even been in one with Jack Allen that was full of human excrement…Lined with plastic shopping bags baggies along the walls, the bags filled with feces. 2 liter bottles filled with urine. Stacks of trash and mountains of cigarette butts. On that occasion, the person we went there to speak with actually lost a portion of their leg due to infection that had set in from the living conditions.

This scene they were describing was not something new to me at all.

They explained how she had gotten some clothes and they even stopped at Dairy Queen to get her an ice cream cone. They said she smiled as she stared out the window watching the buildings go by and ate her ice-cream smiling and talking to them about everyday things….They said they thought it really helped her and she looked better when they got back to the facility…I was smiling and so very pleased with the outcome!

On that day, the day I am originally writing this story about, while making rounds, one of the nursing assistants came up to me and advised me that he staff was in Betty’s room and she was about to pass away.

This was just an hour or so after her trip to her house…I was shocked!

I went to her room to help in any way I could and after the initial assessment of her was made by the Doctor, the Director of Nurses and her floor nurse, I sat with her and held her hand.

She was having difficulty breathing and couldn’t talk to us. Her eyes were closed; she was unconscious and was gasping for air. Her face was grimacing as she breathed and it appeared she was in pain with each breath. I tried to talk to her, tried to get her to respond by gripping my hand tighter, and nothing…She was not responding to anything.

 The doctor stated there was nothing to be done and started to medicate her to address the pain she was experiencing and try to regulate her breathing. When people are passing away, as I was told, there is a regiment of medications that are given to provide comfort and ease for those struggling as they hang on…The regiment had started and I just couldn’t believe this was happening.

Just a few hours ago, this lady was talking to me and not long after that, eating an ice-cream and talking to the girls who took her home…How could this be happening so fast?

Life is so uncertain, so precious and when I tell people to “live in the moment” I mean that because in all reality, the MOMENT is all we have! You just never know what is going o take place in the next instant and here I was, with that evidence literally in my hands! 
 
After her first dose of morphine, she started to relax and was able to mumble “yes” and “no” and was able to tell us she was in pain. With these statements…

Betty, can you hear me?”

“Hmmnnn…..yeeesss”

Betty, are you in pain??”

“Hmnnnnn…..yesssss”

And then she would slip back into unconsciousness…She was really struggling to breathe now, she wasn’t even breathing through her nose canual now…She was gasping for breath with her mouth wide open…. Looooong pauses of no breathing and then a huge GAAAASPPPP” as she would take in a breath….Another looooong moment and no breathing and another huge “GGGAAASSSSSPP” as she would try and breathe.

I vigilantly held her hand the whole time and the Director of Nurses said …

“Brad, does she have any family? We need to notify them.”

Both the Doctor and I said “no” at the same time and I told the D.O.N,…

“She doesn’t have anybody…No family, no friends…no one…She is all alone!”

And I kept holding her hand.

 A second dose of morphine and she was breathing a little better. After about an hour of this she was able to mumble some sentences but they were mumbled and unclear. I continued to hold her hand and assure her that I was there.

“Its OK Betty, I am here…Right next to you, holding your hand. Can you hear me Betty?

And there was no response…

 The staff that I was working with was amazing and rallied around her to try and bring her some comfort. 30 minutes more go by and she stated in a mumbled voice, eyes closed, gripping my hand…

"I don’t want to die.”

And I was swallowing those lumps again in my throat…I had to be strong for Betty…I HAD TO!!!


She was passing away.I sat with her, the doctor and three nurses and I held her hand, stroking her arm, trying to re-assure her that I was there and not leaving. A few minutes later, she slipped off into unconsciousness again and her breathing started to slow down even more...

Now the gaps between breaths were even longer and the gasps for air even larger…I was 2 feet from her face, watching her intently, speaking to her, and letting her know I was there. Stroking her arm and her hands, doing everything I could to assure her she wasn’t alone.

Her breathing slowed….gasps were less frequent and not as big now…..I started to count between breaths and it was 2-3 breaths a minute now. I was trying as hard as I could to hold back the tears but it wasn’t helping…They rolled down my cheeks as I would not let go of her hand to wipe them away.

The staff would come in and out of the room from time to time to check on her and me and then the Doctor came in and stood at the end of the bed…

“You know, when people pass away like this, they get to a place of euphoria….Like people who lock themselves in the garage with the car running… The lack of oxygen actually diminishes the pain”

I don’t know if that’s true and I am sure he has studied that his is true but unless you have been there, how does one actually know this is a truth?

Another dose of morphine….2 breaths a minute now and I was on the edge of my seat, holding her hand, stroking her arm, sobbing quietly with my eyes closed and reflecting on the time we spent together chatting. Reflecting on her life and all the things she had done and seen and then reflecting how alone she was in the world…How totally alone she had been for so long now…

Yes, there has to be something greater than this beyond…there has to be! The God I understand is far to caring to let it be any other way, and I am by far a “religious man.”

I sat with her for the last minutes of her life, holding her hand, stroking her arm and trying to bring her some comfort as she passed on to whatever is next after this life...

One breath a minute now… barely gasping…

I watched her and held her hand as she took her last breath… No more gasps, no more breathing, and the doctor pronounced her.

The Doctor walked up to the side of the bed, kissed her on the forehead and said

“Gods Speed Betty”

Turned and walked out of the room… I was alone now with the shell of the woman I knew …just a shell…No life left…She was gone.


Now I have been witness to people dying in many different scenarios. Car accidents, gun shots, stabbings, etc...

I even made a call on a Sunday morning to a shooting that had taken place…It was at some run down trailer park in the Bayshore, apparently the guy had gone to jail the night before for a drunken fight with another resident of the park. He got out of jail the next morning and went over to the guy he was arguing with the night before trailer. From the statements, the guy had gone over to “beat the guys ass” for sending him to jail.

He walked up on the guys porch, started to make numerous threats, the guy inside trailer told him to leave and get away, the guy opened the door to go after the guy and he pulled a gun and shot him right in the chest.

When I got to the scene, the guy was in a woman’s arms, she was sitting on the ground, had his head in her lap, she was crying and as I walked up to the guy, I could see the fear in his face.

As I stood over him and her I could see him looking at me with his eyes bugged out, his lips were moving but no words were coming out and he was taking what we called in that field “Death Gasps.” These are raspy girgly gasps of air and generally, if you hear that from someone, there isn’t much hope when no medical personnel are on scene.

As I walked up to the guy, he looked over at me, took two huge death gasps as he looked at me with terror in his face, and died….

That quick…

Just like that…

GONE!

That was also a whole different lifetime ago, different scenario, I was a whole different person then; so this was different.

I even remember talking to my wife and friends about how I was concerned because I felt like the job I was doing was de-humanizing me. I am not sure if it’s the time away from seeing the tragedy of the world or maybe I simply have changed but this was difficult… This was hard for me…Very hard!

I can clearly remember so many people who I have been with when they died and also remember that there was a time when I had no real emotional response. It was my job and I had to detach myself from it. I had to take the reality of the suffering out of my psyche because if I didn’t, I would never be able to focus on the task at hand. My job, my calloused soul going to work!

As I sat there with Betty, maybe 30 seconds after she was pronounced, one of the nurses walked in and opened a window behind me. I later found out that this was to “let the soul out.” And I oddly found great comfort in that act…Another lesson learned.

At that time, I was happy for this emotional overload because it reminds me of the caring person I long to be, and reminds me that I AM that! I am able to tell now that because of what I was experiencing, I was no longer so jaded and calloused….I had returned to that caring person I had always thought myself to be. There was relief in Betty’s passing on many levels…and pain on many different levels.

There is a “process” that takes place in long term care to “prepare the body” and the staff had come in and asked if they could start this process. They remove any medical devices, clean up any bodily fluids, dress them in what they are wearing as best can be, cross their arms over their chest and then cover them with the sheet.

I nodded to the staff, knowing I couldn’t speak any words, and went back to my office to gather myself.

When I got back to my office, I sat in my chair took a deep breath (which felt like it was the first one I had taken in months) and let it out…With it came the emotion… I wasn’t sobbing or over run with emotion but I was teary eyed and smiling…I had no doubts that Betty was in a better place…Hopefully seeing her loved ones passed, restored to her best and embraced with the warm light of whatever is beyond this existence we know as “living.”

I also was confident in knowing that Betty didn’t die alone, and on the last day of her life, she got to take a road trip and eat ice-cream… There are worse ways to go! I was with her, by her side and comforting her as she took those steps into what’s next.

We are best served to live in the moment…We are best served to stay focused on the NOW.

Shake off past problems and suffering as there is absolutely nothing you can do about the past….The only reality in the past is your memories of it… Make it great memories!

Are you stressing about that next car payment or about that rent that’s due in three weeks??

DON’T!!

Don’t stress about it, make it a focus and keep driven towards the goal, but don’t get so much anxiety about things that are out of your control.

I have known for some time that I am only able to control the things I can, and the things I can’t, I have to let them work themselves out. TRUST THE PROCESS!!

I care about what takes place in our Country, I care about the starving children in other places, I care about the environment, but I can only control right now, right here, in this moment….And from there, GREAT things are born…IN THE MOMENT!


I hope this story reminds people of how special the people in our life are. We can get so caught up in the drama of life that we often forget about the things that make this life so special. I hope this will encourage you to make that call you have been putting off, send that card you keep telling yourself you are going to send, stop by and see that old friend you haven’t seen in a while or simply take a minute and reflect on the people who have made your life so special.

Quit putting off for tomorrow what you can make a reality today... The way to minimize regrets and guilt is to DO IT NOW! Because NOW is all we really have!

 I guess it is my destiny to work with, and for people, but as in anything, there is the bitter, and the sweet on this day, in this experience, I had a little of both!

Gods Speed Betty! Gods Speed!